About the Role:

• We are looking for a Claims Repricing Specialist to join our team.The Claims Repricing Specialist will be responsible for reviewing medical claims selected for payment integrity audits and ensuring they are priced accurately based on the insurer's policies, contracts, and reimbursement schedules. 

Responsibilities: 

• Utilize claims processing systems to reprice claims and ensure data integrity.
• Reprice medical claims based on contracted rates, including , PPO, HMO, and other networks. 
• Apply the appropriate pricing, contractual rates, and reimbursement methodologies.
• Ensure that all pricing changes are well-documented and communicated clearly.
• Review medical claims for accuracy in accordance with insurance policy guidelines.
• Ensure that claims are processed correctly in terms of eligibility, coverage, and benefits.

Education Qualification: -

• High school diploma or equivalent (Associate's or Bachelor's degree in healthcare or business preferred).
• Knowledge of medical billing codes (CPT, ICD-10), insurance terminology, and claims processing systems.
• Knowledge of reimbursement methodologies and healthcare contracts.
• Familiarity with different types of insurance plans (PPO, HMO, etc.). 
• Experience with claims management systems (e.g., Facets, QNXT, or similar).

Required Skills: -

•  2+ years of experience in medical claims, claims processing, or insurance repricing.